Intraoperative communication and team coordination during early open-console robotic surgical system implementation: a prospective mixed-methods observational study

Robotic-assisted surgery (RAS) separates the console surgeon from the bedside team, increasing reliance on explicit communication and shared awareness. Open-console platforms may alter this dynamic, but prospective evidence during early implementation is limited. This study examined intraoperative communication, coordination, and contextual barriers and facilitators with a newly implemented open-console robotic system.

We conducted a prospective, single-center, convergent mixed-methods observational study of the Hugo RAS at a Canadian hospital from February to March 2026. A surgical robotics implementation specialist observed 20 procedures using a structured checklist covering eight domains. Surgeons, bedside assistants, circulating nurses, and scrub nurses completed 62 post-procedure, case-linked survey forms. Survey responses were summarized descriptively. Field notes were analyzed using framework-based thematic synthesis, and findings from the data sources were integrated.

Across 62 case-linked survey forms, participants reported high levels of verbal communication effectiveness (mean 4.60/5), instruction clarity (mean 4.55/5), and perceived communication support provided by the open-console configuration (mean 4.81/5). Perceived procedural difficulty (mean 2.06/5) and communication-related stress (mean 1.32/5) were low. Field observations indicated that communication was generally concise and role-specific, with greater communicative demands during high-coordination transitions, teaching, and in unfamiliar room configurations. Ambient noise and overlapping conversations occasionally diminished message clarity.

Open-console RAS was associated with effective perceived communication between surgeons and bedside staff and low communication-related stress, alongside localized increases in communication demands during non-routine or transition-intensive periods. These findings identify practical targets for staff onboarding and closed-loop communication that merit evaluation in multicenter comparative studies.